Background

This paper summarises Effective Health Care, volume 6, number 2,1 which is based on a systematic review to evaluate the effectiveness of interventions to promote the initiation of breast
feeding.2

Breast feeding is a key public health issue. Health benefits associated with breast feeding include protection against gastroenteritis,
respiratory infection, otitis media, urinary tract infections, and diabetes mellitus for the infant3 and premenopausal breast, ovarian, and endometrial cancers for the mother.4 These health benefits may be countered by some concern over pathogen transmission through breast feeding, for example, in
the case of HIV.5

Despite national initiatives, successive surveys have shown that the incidence and prevalence of breast feeding in the UK
have remained static since 1980. In 1995 62% of women started to breast feed in England and Wales, 48% in Scotland, and 41%
in Northern Ireland.6 (Figures standardised for mother's age and age finished full time education.)

Furthermore, breast feeding rates in the UK have been found to be strongly associated with social class; 90% of women from
social class I started to breast feed in 1995 compared with only 50% of women from social class V.7 Policies to increase the prevalence of breast feeding have been recommended in a recent Department of Health action report
on reducing health inequalities7 (arising from the White Paper Saving lives: our healthier nation8)

Promoting initiation

This bulletin is based mainly on interventions which have been evaluated using randomised controlled trials (RCTs) or non-RCTs.
Reference is made to findings from before/after studies where there is limited or no evidence from RCTs and/or non-RCTs. Details
of all the studies together with the methods used are available in the full report.2

The studies were difficult to synthesise because they vary according to the populations studied …